How To Maximize Revenue With Clinical Documentation Improvements

With the healthcare payment market continually in flux, hospitals are doing all they can to maximize the revenue that they receive for their work. Not a dollar can slip through the cracks with the narrow margins that most hospitals are operating at. Many hospitals have recognized the merits of a strong clinical documentation improvement (CDI) program to increase their billings per case.

The benefits of a strong CDI program are numerous. Not only are financial improvements quickly realized, but the benefits can also carry over into quality and patient outcomes.  As this article by Jacqueline Belliveau at RevCycle Intelligence reports:

“Nearly 90 percent of hospitals that used CDI solutions earned at least $1.5 million more in healthcare revenue and claims reimbursement, a 2016 Black Book Market Research survey found.

The additional revenue primarily stemmed from case mix index enhancements generated by CDI programs, said 85 percent of hospital finance leaders.

Hospital case mix indices measure the average severity level of cases treated within the organization. Higher case mix indices indicate that hospitals are treating more complex cases and should receive higher reimbursements for their efforts.

Increasing case mix index can significantly boost revenue. After implementing a CDI solution, Arizona-based Summit Healthcare Regional Medical Center increased the organization’s case mix index by 20 percent, with major complication/comorbidity capture rising 37 percent and complicating condition identification growing 22.8 percent.

The case mix index and additional diagnoses capture translated to over $558,000 more revenue in just a few months.

In addition to revenue enhancements, CDI also advances patient care. Care team members can collaborate and create personalized treatment plans when they have access to an accurate and detailed patient record.

As a result, provider and organization performance on key quality measures may improve. For example, Heritage Valley Health System in Pennsylvania reported a significant patient care improvement after implementing a CDI initiative. Better documentation and coding reduced their predicted mortality rate by 27 percent.”

To learn more on how to implement a CDI program, and how to overcome common obstacles, read the entire article at: Maximizing Revenue Through Clinical Documentation Improvement

As the article states, a common roadblock to a successful CDI program is physician buy-in. As physicians already complain about burn-out from electronic documentation of their daily encounters, adding a CDI program to their plate may face resistance. One way healthcare providers can counter this is to arm their physicians and staff with the necessary tools to provide both excellent patient care and accurate and complete documentation of their encounters.  One way that hospitals can reduce the burden on clinicians is to eliminate redundant tasks in the EMR.  For example, natural language processing tools can help turn transcription data into notes that need to only be verified instead of typed in from scratch.  Additionally, automated data capture systems, such as iRISupply, can provide high quality data by integrating RFID data capture technology directly into your EMR, eliminating the need to have clinicians re-enter supply and implant information into the EMR during hectic procedures.